BACKGROUND AND OBJECTIVE: Acute hematogenous osteomyelitis (AHO) is a severe infection in children. Drainage of purulent collections in bones provides specimens for culture as well as therapeutic benefit. Interventional radiology (IR)-guided procedures may serve as a less invasive means of culture in select patients. We examined the impact of IR and surgically obtained cultures in the diagnosis and management of AHO.

Background Bacteremia is often one factor used in deciding the need for prolonged intravenous antimicrobial therapy in osteoarticular infections (OAI). We examined treatment practices and outcomes of bacteremic S. aureus osteoarticular infections (BOAI) evaluated at Texas Children’s Hospital (TCH). Methods Cases of acute hematogenous OAI in children with positive blood cultures for S. aureus at TCH from 2011–2014 were reviewed. Orthopedic complications included chronic osteomyelitis, growth arrest, pathologic fracture, avascular necrosis and chronic dislocation. Acute kidney injury (AKI) was defined as a doubling of the baseline creatinine. Results 192 cases of S. aureus OAI were identified with 102 cases of BOAI included (35 MRSA). 25 patients were discharged home on oral antibiotics. Patients discharged on oral antibiotics had a shorter duration of fever, a more rapid decline in C-reactive protein and were less likely to have MRSA. The frequency of orthopedic complications did not increase in patients who received early transition to oral antibiotics. For patients with MRSA bacteremia the rates of complications between those who received ≥ 7 days vs. < 7 days of vancomycin did not differ. Vancomycin serum troughs > 15 µg/ml were not associated with a decreased duration of fever, bacteremia or hospitalization, need for repeat operation or orthopedic complications but were associated with AKI. Conclusion Bacteremic S. aureus OAI are associated with substantial morbidity. Early transition to oral therapy may be a safe option for select patients with S. aureus BOAI, including those due to MRSA. Prolonged courses of vancomycin and vancomycin troughs > 15 µg/ml were not associated with improved outcomes for MRSA OAI.